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DAN y1VAWUIN UVUN I T Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 600 E MAIN STREET <br /> STOCKTON, CA 95202 V O COPY <br /> Phone: (209) 468-3420 <br /> INVOICE Account ID AR0033755 <br /> Facility ID FA0018975 <br /> Date Printed 3/31/2010 <br /> A <br /> A C TRANSMISSION RE : A C TRANSMISSION <br /> 4035 N WILSON WAY 4035 N WILSON WAY#8 <br /> STOCKTON, CA 95205 STOCKTON, CA 95205 <br /> OWNER : SERGIO MORALES <br /> Date Health <br /> Amount <br /> Program Description <br /> Invoice# IN0200700---Date of Invoice: 2/212010 IIIIIIIII IIIVIIIIIIVIIIIIIIIVIVIIIVIVIII/IIIIII VIII////IN <br /> 2/1/2010 2244 2010 HAZMAT FEE $ 85.00 <br /> 2/1/2010 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 <br /> 2/1/2010 ERSC ELECTRONIC REPORTING SURCHARGE $ 25.00 <br /> 3/20/2010 9987 Haz Mat Program Penally Fee $ 8.50 <br /> Total for this Invoice $ 142.50 <br /> Payment Due Date 314/2010 <br /> TOTAL DUE this Billing Period $ 142.50 <br /> J . �t <br /> DelingUent charges <br /> will be forwarded to <br /> COL1LE.V '9M <br /> it 30 days, <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For DES I HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30Daysthereafter <br /> 5254.rpt <br />